| NPI | 1346068632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35264) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY35264) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA PSY35264) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: CA PSY35264) | |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |